Major Break-Through In Cancer Drugs: That’s the Good News
There’s good news and bad news for cancer patients. New drugs more effective at targeting the deadliest forms of cancer are coming on-line. That’s the good news. The bad news is that no one can afford them
New drugs have always been relatively expensive. It takes years of research and development, rigorous testing and a tedious Food and Drug Administration (FDA) approval process before they can even be tested on humans. Successful drugs must be priced to cover not only their own cost of development but that of all the failures that preceded them. Complex and expensive manufacturing processes can drive the cost still higher.
Cancer, the big ‘C’, the most universally dreaded of all diseases, has defied all efforts to find a cure. One reason is that what we call cancer is really many individual diseases with distinct conditions and behaviors. Until recently, patients faced a standard regime of chemotherapy, radiation and surgery, methods which gained mixed results and weakened the entire body. Instead, the new drugs target specific forms of cancer by changing the cellular, chemical, or genetic environment that allow that particular type to thrive.
Unlike earlier cancer treatments, however, many of these new developments benefit only a small subset of cancer patients. Consequently, the tiny market and new technology propel the drug prices into the stratosphere costing $100,000 and more per treatment. As a result, these new drugs will spike total spending on cancer drugs by an estimated 42% in the next 2 years!
Although Otis Brawley, chief medical officer for the American Cancer Society, refers to these new developments as the “next frontier”, he also cautions that they’re not cures. In fact, with a few exceptions, the new cancer drugs have but a marginal effect on most patients, extending lives a few weeks or months. Provenge, a prostate cancer drug, extends lives by an average of 4 months at a cost of $93,000 per treatment. In treating colon cancer, Avastin, costs $100,000 and extends lives less than 5 months. The few cases where drugs do fulfill their promise fuel the hopes of the afflicted and result in a desperate demand that everyone be treated regardless of the cost.
These super-costly drugs put pressure on a medical delivery system already lacking any incentive to reduce costs. People seldom directly pay for expensive treatments. Someone else – an insurance company, the government or an assistance program – covers most of our medical costs so people rarely make medical choices based on cost. Medicare, a major driver of health care costs in this country, is forbidden by law to consider cost in making coverage decisions.
As a result, our fee-for-service dominated health care system gives medical providers an incentive to administer expensive treatments. Consequently, doctors don’t consider cost in prescribing treatments. Dr. Eric Nadler, a researcher at Harvard Medical School, studied the attitudes of oncologists on this issue and found 80% of them would prescribe a drug costing up to $70,000 even when the patients life would be extended by no more than 2 months. Finally, there is no incentive for drug companies to develop low cost drugs or drug delivery systems. On the contrary, people are demanding cancer ‘cures’ and insurance companies and governments are pressured to pay whatever is being charged. How can this situation be better managed?
Is government the answer? With health care entitlements already accounting for most of our record breaking deficits, it’s not probable. That being said, many feel government is still our only possible solution. Given high cost and limited resources, however, it’s obvious that not everyone wanting these drugs would get them. Rationing, on some basis, would be called for. Should it be based on ability to pay? Probably not. Almost everyone would qualify. And, if only poor people were helped, we’d have tax payers paying for cancer drugs they themselves couldn’t have.
In Great Britain, where government is the answer, they use a formula based on longevity, quality of life, and comparable costs to determine what cancer treatments people should receive. In considering the new oncology drugs, their National Institute for Health and Clinical Excellence (NICE) eliminated several of the most expensive ones because of their limited value relative to cost.
One study conducted by a team of bio-ethicists and health policy experts compared the British system with that of the U.S. and determined neither approach solved the problem of providing expensive drugs of limited value to people who are facing the end of their lives. They admitted they had no answer.
During the last 2 weeks, I informally polled not only friends but others I encountered at the fitness center, in my doctor’s waiting room, and at our neighborhood 4th of July planning meeting. Respondents spanned the entire political spectrum. Universally, people felt that patients and their families should be responsible for expensive treatments that offered short life extensions. Many stated that death was a fact of life and it was wrong to expect others to pay to delay the inevitable.
If people had to pay for the drugs themselves, fewer people would elect to do so. With fewer buyers, drug companies would have to find a way to lower prices or work harder to develop drugs with better results. But with fewer buyers will drug companies still have the resources to push through to a real cure for cancer? I’m guessing ‘yes’ but it might take a bit longer…..